J Korean Orthop Assoc.  2019 Oct;54(5):411-417. 10.4055/jkoa.2019.54.5.411.

Comparison of the Clinical Outcomes of a Single Injection Adductor Canal Block with the Concomitant Use of Transdermal Buprenorphine and Continuous Adductor Canal Block after Total Knee Arthroplasty

• Huh JW
• Park MJ
• Ko YC
• Ha DJ
• Park JH
• Lee WM

• KMID: 2461230
• DOI: http://doi.org/10.4055/jkoa.2019.54.5.411

Abstract

PURPOSE
To compare the clinical outcomes of single injection adductor canal block (SACB), continuous adductor canal block (CACB), and the concomitant use of transdermal buprenorphine after total knee arthroplasty (TKA).
MATERIALS AND METHODS
A total of 125 patients who underwent TKA were divided into three groups and the clinical results were retrospecitively compared. Group I was comprised of patients with pain controlled by SACB (n=41). Group II consisted of patients with pain controlled by both SACB and transdermal buprenorphine (10 µg/h) (n=44). Group III contained patients with pain controlled by CACB (n=40). The visual analogue scale (VAS) was used as the pain control indicator and the patients were measured on a VAS for resting on the bed (VAS-Rest) at 12 hours, 24 hours, and 48 hours after surgery. The VAS while doing continuous passive motion (VAS-CPM) on the first and second postoperative day was also measured. In addition, the total amount of medications used (Butopahn, Tridol, and Ketorac) for the intravenous patient controlled analgesia (PCA) was counted for 48 hours after surgery. As the indicator of the functional recovery outcome, the incidence of nausea and vomiting was observed for 48 hours after surgery. The maximum knee joint flexion range and maximum walking distance on the first and second postoperative day, and the total length of stay at the hospital were compared.
RESULTS
The VAS-Rest was similar in the three groups at 12 hours after surgery, but at 24 hours and 48 hours after surgery, group II and III a lower VAS-CPM and total amount of medications used for PCA than group I (p<0.05). The three groups showed a low incidence of nausea and vomiting, maximum knee joint flexion range, and similar walking distance and total length of stay at the hospital.
CONCLUSION
The combination of SACB and transdermal buprenorphine has great pain control effect initially. On the other hand, it is not associated with catheter complications and it is convenient to use and safety toward the renal function. Therefore, the concomitant use of SACB and transdermal buprenorphine can be an effective pain control method after TKA.

Keyword

total knee replacement; postoperative pain; single injection adductor canal block; continuous adductor canal block; transdermal buprenorphine patch

MeSH Terms

Analgesia, Patient-Controlled
Arthroplasty, Replacement, Knee*
Buprenorphine*
Catheters
Hand
Humans
Incidence
Knee Joint
Length of Stay
Methods
Nausea
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Vomiting
Walking
Buprenorphine

Figure

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  Figure 1. Adductor canal block. (A) Adductor canal block using ultrasonography; place the epidural catheter after the adductor canal block. (B) Place the needle near the saphenous nerve (SaN). Dist., distal; lat., lateral; med., medial; prox., proximal; FA, femoral artery.

• 

  Figure 2. Mean VAS-Rest and inter-group p-value. The mean VAS-Rest of the II and III groups was lower than that of the I group at every time except for the postoperation period till 12 hours. On the other hand, no significant difference was observed at any point when comparing the VAS-Rest between the II and III groups. VAS-Rest, visual analogue scale for resting on the bed; Group I, single injection adductor canal block (SACB) group; Group II, SACB with transdermal buprenorphine patch group; Group III, continuous adductor canal block (CACB) group.

• 

  Figure 3. Mean VAS-CPM and inter-group p-value. The mean of VAS-CPM was similar in II and III groups, which were both estimated at 24 hours and 48 hours after the operation. On the other hand, both were significantly lower than group I. VAS-CPM, visual analogue scale while doing continuous passive motion; Group I, single injection adductor canal block (SACB) group; Group II, SACB with transdermal buprenorphine patch group; Group III, continuous adductor canal block (CACB) group; POD, post-operative day.

• 

  Figure 4. Mean patient controlled analgesia (PCA) consumption for postoperative 48 hours and inter-group p-value. The mean of PCA consumption was similar in the II and III groups. On the other hand, both were significantly lower than group I. Group I, single injection adductor canal block (SACB) group; Group II, SACB with transdermal buprenorphine patch group; Group III, continuous adductor canal block (CACB) group.

Reference

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